Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels.

PURPOSE: Patients with cryptorchidism can have such short spermatic vessels that it is impossible to place the testicle in a satisfactory scrotal position using conventional orchiopexy. In these cases the most commonly used operation is 1 to 2-stage Fowler-Stephens orchiopexy. We present our surgical experience using staged inguinal orchiopexy without section of the spermatic vessels in patients with short spermatic vessels. MATERIALS AND METHODS: We used 2-stage inguinal orchiopexy in 38 children with intra-abdominal testis or testis peeping through the internal ring and short spermatic vessels (7 bilateral). Spermatic vessels were not sectioned, but were lengthened through progressive traction of the spermatic cord wrapped in polytetrafluoroethylene pericardial membrane (Preclude). In the first stage we mobilized the spermatic cord in the retroperitoneal space and then wrapped it in the polytetrafluoroethylene membrane. We subsequently attached the testis to the invaginated scrotal bottom. At 9 to 12 months we performed the second stage, which involved removing the polytetrafluoroethylene membrane. RESULTS: From the first to the second stage we observed progressive descent of the testicle toward the scrotum. At 1 to 8-year followup after the second stage all 45 testicles were palpable in a satisfactory scrotal position with stable or increased testicular volume. CONCLUSIONS: This technique represents an alternative to Fowler-Stephens orchiopexy, which can be associated with a greater risk of testicular ischemia.

Symptomatic unilateral renal angiomyolipoma in a child with tuberous sclerosis.

We report a case of unilateral renal angiomyolipoma in a 10-year-old boy with tuberous sclerosis. The case is worthy of attention because the symptoms occurred at an early age and because the lesion was unilateral, the latter confirmed at 11-year follow-up. The presentation and treatment are discussed, and the pertinent literature is reviewed. The case demonstrates that it is of clinical importance to monitor renal involvement in children with tuberous sclerosis.

Familial clustering of Helicobacter pylori infection: population based study.

OBJECTIVES: To assess the rate of intrafamilial transmission of Helicobacter pylori infection in the general population and the role of a family's social background. DESIGN: Population survey. SETTING: Campogalliano, a town in northern Italy with about 5000 residents. PARTICIPANTS: 3289 residents, accounting for 416 families. MAIN OUTCOME MEASURES: Prevalence of H pylori infection assessed by presence of IgG antibodies to H pylori. RESULTS: The overall prevalence of H pylori infection was 58%. Children belonging to families with both parents infected had a significantly higher prevalence of H pylori infection (44%) than children from families with only one (30%) or no parents (21%) infected (P<0.001). Multivariate analyses confirmed that children with both parents positive had double the risk of being infected by H pylori than those from families in which both parents were negative. Family social status was independently related to infection in children, with those from blue collar or farming families showing an increased risk of infection compared with children of white collars workers (odds ratio 2.02, 95% confidence interval 1.16 to 3.49). CONCLUSIONS: H pylori infection clusters within families belonging to the same population. Social status may also be a risk factor. This suggests either a person to person transmission or a common source of exposure for H pylori infection.

Serum tumour necrosis factor-alpha is increased in patients with Helicobacter pylori infection and CagA antibodies.

BACKGROUND: Helicobacter pylori causes gastric inflammation secondary to the mucosal release of cytokines and tumour necrosis factor-alpha. AIMS: To investigate whether serum levels of tumor necrosis factor-alpha correlate with Helicobacter pylori infection, CagA antibodies, 13C-urea breath test results, endoscopic, and histological findings. METHODS: Endoscopy (with gastric biopsies), 13C-urea breath test, and serological assay of CagA antibodies and tumour necrosis factor-alpha were performed in 172 dyspeptic patients. RESULTS: A total of 126 patients (73.2%) were infected; of the 126 patients, 84 with CagA antibodies (66.7%) showed a higher prevalence rate of duodenal ulcer (p = 0.03), more severe neutrophil infiltration (p = 0.03) and higher bacterial colonization (p = 0.03) than those without antibodies. CagA+ and CagA- groups differed also in 13C-urea breath test results (p = 0.03). A significant difference in serum tumour necrosis factor-alpha levels was observed between infected and uninfected individuals (p = 0.03) as well as between CagA+ and CagA- patients (p = 0.002). CONCLUSIONS: Helicobacter pylori infection is associated with increased serum levels of tumour necrosis factor-alpha. Subjects who harbour CagA positive strains have more severe mucosal damage, higher bacterial colonization, higher probability of developing duodenal ulcer and higher serum levels of tumour necrosis factor-alpha than those infected with CagA- strains.

Omeprazole in patients with mild or moderate reflux esophagitis induces lower relapse rates than ranitidine during maintenance treatment.

BACKGROUND/AIMS: Patients with reflux esophagitis have rapid relapses after treatment withdrawal. This study was designed to investigate the relapse rate of symptomatic esophagitis during maintenance treatment with omeprazole versus ranitidine after the induction of acute healing with omeprazole. METHODOLOGY: Patients with endoscopically verified acute erosive or ulcerative esophagitis (grade 2 or 3) were initially treated with 20 mg of omeprazole daily for 4, 8, or 12 weeks. After healing, the patients were randomized to maintenance treatment with omeprazole (20 mg every morning) or ranitidine (150 mg twice daily). A control endoscopy was performed at the end of the healing phase and after 6 months of maintenance treatment or symptomatic relapse. RESULTS: Of 231 initially treated patients, 223 were healed (no erosive esophagitis) and entered the maintenance study. The estimated proportions of patients in remission after 6 months of maintenance treatment with 20 mg of omeprazole once per day (n = 102) and 150 mg of ranitidine twice per day (n = 103) were 89.2% and 75.7%, respectively. The single daily dose of omeprazole worked significantly better than the doses of ranitidine (p < 0.001). The omeprazole group, in comparison to the ranitidine group, had a significantly higher number of patients without symptoms (37.8% vs 54.7%) and a lesser percentage of moderate symptoms (9.45% vs 19.8%). CONCLUSIONS: Maintenance treatment with omeprazole (20 mg once daily) is superior to ranitidine (150 mg twice daily) in keeping patients with mild to moderate erosive reflux esophagitis in remission over a 6-month period.

Omeprazole 20 or 40 mg daily for healing gastroduodenal ulcers in patients receiving non-steroidal anti-inflammatory drugs.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are strongly associated with gastroduodenal ulcers, and the management of patients with NSAID-associated ulcers represents a common clinical dilemma. AIM: To assess NSAID-associated ulcer healing during treatment with either standard (20 mg) or high dosage (40 mg) omeprazole. METHODS: One hundred and sixty-nine patients chronically ingesting diclofenac, ketoprofen, indomethacin or naproxen for osteoarthritis or rheumatoid arthritis, who had abdominal pain and an endoscopically proven gastroduodenal ulcer, were evaluated in a randomized, double-blind, dose regimen trial with omeprazole 20 mg o.m. (n = 81) or omeprazole 40 mg o.m. (n = 88). Ulcer healing was assessed endoscopically at 4 and 8 weeks in the case of unhealed ulcers. Patients continued their usual daily dose of anti-inflammatory medication throughout the study period. RESULTS: One hundred and fifty-six patients completed the study (77 patients taking 20 mg omeprazole and 79 patients taking 40 mg omeprazole); 12 patients were lost during follow-up and one patient reported an adverse event. Cumulative ulcer intention-to-treat healing rates at 8 weeks were 88% (95% confidence interval (CI) = 79-95%) for the 20 mg omeprazole group and 96.2% (95% CI = 89-99%) for the 40 mg group, and 97.1% (95% CI = 90-100%) for the 20 mg omeprazole group and 98.6% (95% CI = 93-100%) for the 40 mg group by per protocol analysis. There were no statistically significant differences between the two groups. Symptom relief did not differ significantly between the two treatment groups. CONCLUSION: Both standard and high doses of omeprazole are equally safe and effective regimens for the treatment of NSAID-induced gastroduodenal ulcers when anti-inflammatory treatment is not discontinued.

Sucralfate gel for symptomatic chronic gastritis: multicentre comparative trial versus sucralfate suspension.

The object of this study was to compare the efficacy of a new sucralfate gel formulation and the standard sucralfate suspension in the treatment of chronic gastritis. This multicentre randomized trial included 368 dyspeptic patients with endoscopic features of histologically confirmed chronic gastritis. Patients were randomized to a six week treatment with either 1 g bid sucralfate gel or 1 g qid sucralfate suspension. Endoscopic and histological assessment plus urease test for Helicobacter pylori were performed at 0 and 6 weeks. Clinical evaluation of symptoms were obtained at 0, 3 and 6 weeks. Results showed that both treatments were equally effective in promoting symptom relief, in inducing endoscopic and histological healing or in the improvement of the lesions. Therefore sucralfate gel is as effective as the standard preparation in the treatment of chronic gastritis, with the advantage that its b.i.d. administration improves patients' compliance.

[Therapeutic effectiveness of bamifylline in elderly patients with COPD]. / Valutazione dell'efficacia terapeutica della bamifillina in pazienti anziani affetti da BPCO.

We studied the clinical and instrumental modifications of 20 patients (mean age: 67.95 +/- 1.23 years; 13 males, 7 females) suffering from COPD (less than 65% theoretical FEV1), during treatment with bamiphylline. At basal time, and after 1, 2, 3, 4, and 6 months of therapy we performed a clinical and spirometric examination. All spirometric parameters (FEV1, VC, MEF25-75, Tiffeneau Index) increased significantly (p less than 0.01 - ANOVA1) since the first control performed after 1 month of treatment. This trend was confirmed in the successive controls. Analogue results were observed for emogasanalytical (P-CO2-PO2) and clinical (cough and dyspnoea) parameters. During the experimental research we did not observe side effects due to the xanthine-derivative (bamiphylline) under study or modifications of the main haematochemical tests. Therefore we believe that bamiphylline must be considered an effective therapeutic tool for COPD therapy.

Pharmacokinetics of bamifylline during chronic therapy.

The pharmacokinetics of bamifylline (Briofil) has been studied in 6 healthy volunteers both after acute and chronic administration. The kinetic variables were similar both after the first dose and after chronic treatment and no significant accumulation of the drug was observed after 7 days of therapy with bamifylline (600 mg b.i.d.). The analysis of minimal concentrations of bamifylline did not yield evidence of circadian variation in the kinetics of this drug; large differences among subjects and within each subject on different days may be explained by changes in drug bioavailability. Very low plasma levels of bamifylline were observed at the end of the dosing intervals in 50% of the cases; this observation does not necessarily invalidate the efficacy of this dosage regimen because the active metabolite of bamifylline (AC119) might contribute to the bronchodilator activity of this drug.

The use of low molecular weight heparins for postsurgical deep vein thrombosis prevention in orthopaedic patients.

The prophylactic antithrombotic efficacy of a low molecular weight heparin was compared with a traditional unfractionated calcium heparin after orthopaedic surgery in 140 patients. Deep vein thromboses were detected in legs either by Doppler sonography or [125I]fibrinogen uptake tests in five (7.1%) and seven (10%) patients, respectively. The capacity of both drugs to prevent deep vein thrombosis was demonstrated. Compared with the control group, those who used low molecular weight heparin showed a significant increase of activated factor X inhibition and smaller increases in activated partial thromboplastin times. Tolerability of both drugs was good, with a low incidence of local side-effects.

Positive fluorescent treponemal antibody reactions in diabetes.

In a survey of 129 diabetic patients and 142 normal individuals, a significantly higher percentage of positive reactions in the fluorescent treponemal antibody-200 (FTA-200) test was found among diabetic patients than in the normal population. Absorption of all FTA-200-reactive sera with an extract of Reiter's treponeme eliminated most of the positive reactions in sera from diabetic patients, and three of the five positive reactions detected in sera from apparently normal subjects. On immunoelectrophoresis, precipitin bands developed most frequently between the Reiter sorbent and sera from diabetic patients positive in the FTA-200 test. Serum components responsible for FTA reactivity and precipitin reactions against the sorbent were resistant to treatment with mercaptoethanol, suggesting antibody of the IgG class. Cross-reacting antibodies produced in response to normal treponemal flora, and perhaps acquiring enhanced reactivity by means of nonspecific interacting substances in sera peculiar to the altered physiological state of diabetes, are suggested as possible causes of positive reactions of unabsorbed sera. No correlation could be made between age of the diabetic patient, treatment or duration of the disease, and FTA or precipitin reactivity of the patient's serum.